An Empathetic Approach to Human-Centric

Requirements Engineering Using Virtual Reality

Nicholas Chong
Software Engineering Research Project
Monash University
Melbourne, Australia
ncho0010@student.monash.edu
Emmanuel Chu
Software Engineering Research Project
Monash University
Melbourne, Australia
echu0019@student.monash.edu
Adrian Nadonza
Software Engineering Research Project
Monash University
Melbourne, Australia
anad0008@student.monash.edu

Sienna Marie Rodriguez Sothearith Tith Jin Shan

Software Engineering Research Project Software Engineering Research Project Software Engineering Research Project
Monash University Monash University Monash University
Melbourne, Australia Melbourne, Australia Melbourne, Australia
srod0005@student.monash.edu stit4@student.monash.edu jngg0042@student.monash.edu

Prof. John Grundy A/Prof. Thuong Hoang

Faculty of IT Faculty of Sci Eng, Built Env
Monash University Deakin University
Melbourne, Australia Melbourne, Australia
john.grundy@monash.edu thuong.hoang@deakin.edu.au

Abstract—We explored the use of virtual reality (VR) in
assisting software engineers to better understand the perspectives
of the end user for the purpose of human-centric requirements
elicitation, with a focus on users diagnosed with attention-
deficit/hyperactivity disorder (ADHD). We conducted a pilot
experiment using a virtual gym environment, instructing the par-
ticipants to complete activities whilst under visual and auditory
distractions similar to symptoms of ADHD. Results indicated
an increase in understanding the perspectives of someone with
ADHD and an awareness of potential challenges with software
not intentionally designed for ADHD users.
Index Terms—Software Engineering, Virtual Reality, Human-
Centric Requirements Engineering, Attention Deficit Hyperactiv-
ity Disorder
I. I NTRODUCTION
Software engineers are often very different to their end
users, due to their differing human aspects of age, gender, cul-
ture, language proficiency, socio-economic status, technology
proficiency, personality, cognitive style, emotions, physical and
mental challenges [1][2]. As a result, there are many issues
related to the challenges and frustrations of software that fail
to meet the needs of diverse end users. J.C Grundy says that
“many issues with current software relating to its poor fit with
its target end users. . . can be traced to a lack of understanding
and incorporation during software engineering of end user
human aspects” [1]. In other words, software engineers are
failing to meet the needs of diverse end users due to a lack of
understanding during the requirements engineering phase.
One particular user group that will be investigated is neuro-
diverse users. Neuro-diversity describes people with devel-
opmental or neurological conditions. Neuro-diverse people
experience the world around them in many different ways
[3] and conditions range from autism, dyslexia and ADHD.
In this research, we focus upon neuro-diverse users with
ADHD. Attention-deficit/hyperactivity disorder (ADHD) is
a behavioural disorder that affects many adults [4]. People
with ADHD show a persistent pattern of inattention and/or
hyperactivity-impulsivity that interferes with functioning and
development [5]. A study by M. R. Morris, A. Begel and
B. Wiedermann [6] of a “large software company” (840
engineers) found a lack of representation of ADHD among
software engineers. 92.98% of engineers they surveyed were
neurotypical, while the remaining 7.02% was neuro-diverse.
Hence, the underrepresentation of neuro-diversity among soft-
ware engineers suggests that it contributes to this gap in
human-centric requirements engineering.
A. Motivating Example:
Adefila A et al’s “myShoes – the future of experiential
dementia training?” [7] focuses on a virtual reality (VR)
environment simulating the conditions of dementia to improve
dementia symptom understanding, and also empathy for peo-
ple with dementia. VR technology is considered to be the
“ultimate empathy machine” [8] in comparison to traditional
perspective taking, however, “much remains to be validated
and experimented” [7]. Furthermore, the current research
available today focuses on using VR technologies on the
diagnosis of ADHD within children [9] and the treatment of
ADHD, but not within a software engineering context. There
has not been enough empirical evidence to explore whether
VR can help software engineers design better solutions for
end users with ADHD and this identifies a need to evaluate the
utilisation of VR for human-centric requirements engineering.
Wang. O et al (2021) research also emphasises the need for
setting up a virtual environment “to understand the impact of
different environments on the user requirements” [10] in con-
junction with software use. Another step in the “Requirements
Elicitation Process Based the VR Platform” by Wang. O, et
al (2021) proposes ‘Simulating User Conditions’, in particular
on users with special accessibility requirements.
Our research extends upon Wang. O et al’s Fitness App in
a virtual gym environment. We added an additional feature of
simulating ADHD by toggling different symptoms on and off
in the platform. Before the simulation, participants complete
a pre-experiment questionnaire to assess their knowledge of
ADHD and the Davis Interpersonality Reactivity Index (IRI) to
measure their dispositional empathy. After the simulation, par-
ticipants complete a post-experiment questionnaire to compare
their new understanding of ADHD and identify how they could
better design solutions for end users with ADHD. Observations
are also made by investigators during the experiment.
B. List of key contributions of the work done
Our key research contributions are summarised as below:
• A VR platform that simulates ADHD symptoms in a
virtual gym environment.
• A pilot study that evaluates whether utilising VR as an
empathetic approach for human-centric requirements en-
gineering helps software engineers design better solutions
for end users with ADHD.
This research paper is organised as follows. Section 2 reviews
the related work. Section 3 presents the research aims and
research questions. Section 4 presents the research method-
ology. Section 5 presents the results. Section 6 discusses the
results. Finally, section 7 concludes this paper and presents
future research work.
II. R EVIEW OF L ITERATURE
Davis defines empathy as the “reactions of one individual to
the observed experiences of another [11]. Empathy has been
widely studied and investigated with the use of VR where it
has been used to help people empathise with certain groups
of people such as refugees, homeless people and people with
impairments. Previous studies have shown how VR’s ability
to create environments that reflect the real one and give the
illusion of being another person have increased a user’s overall
sense of empathy [15] [16]. In accordance with empathy in
requirements engineering, virtual reality provides something
in the elicitation of requirements engineering that the conven-
tional methods lack - immersion and natural affordance for
perception. The sense of presence and immersion in VR, so
often used interchangeably, describes the psychological sense
of “being there” in a virtual environment. In accordance with
immersion and sense of presence in relation to requirements
elicitation, a study by Bhimani et al. shows the effectiveness
and usefulness of VR in the elicitation of requirements due the
feeling of being fully immersed. It was found that participants
in the study showed positive responses to the use of VR in col-
lecting requirements [14]. Requirements elicitation becomes
more complicated when it involves special needs users as
they are impaired due to disabilities as the requirements or
knowledge from these stakeholders are harder to convey or
express. Another research by Bhimani et al. studies the use
of a VR environment to enhance requirements elicitation by
developing a generic environment for each disability to provide
a sense of “presence” which can help requirement elicitation.
In the same study, Bhimani et al. also posits “Indeed, VR has
already proven itself worthy in other industries such as physio-
therapy, and medicine; we believe it will benefit the design and
development process of software as well, namely requirements
elicitation, when the characteristics of the stakeholders suggest
the existence of a relevant knowledge difficult to be worded.”
[11]. A similar study on the effectiveness of VR in health by
Chirico et al. showed the use of VR as a calming intervention
that promotes emotional well-being in cancer inpatients. The
study also found that VR had a positive impact on patients’
distress, anxiety, cancer-related psychological symptoms and
even helped during painful procedures and chemotherapy. [12].
Another study conducted by T. I. Chowdhury et al. explores
the idea of an embodied experience via a virtual avatar to
reduce negative biases associated with disabilities, which in
other words means an increase in empathy. This study was
carried out by creating a wheelchair interface and a DS with
a tracked Head Mounted Display (HMD) that would have a
significantly larger effect on participants’ information recall
and their implicit association towards people with disabilities
(PwD) than a desktop monitor and gamepad [13].
Past studies have determined the effectiveness of virtual
reality as a medium to elicit empathy (Dyer et. al. 2018,
Adefila et. al. 2016) and in recent years, VR has become
increasingly used to support educational training, particularly
in the health science and social care fields [17]. A study
conducted by Dyer et al. (2018) utilised VR software that
enabled medical students to simulate being an elderly patient
with age-related diseases such as macular degeneration and
high-frequency hearing loss. It was found that introducing an
innovative new teaching modality to the medical, physician
assistant, physical therapy, and nursing curricula enhanced
students’ understanding of age-related health problems and
increased their empathy for older adults with vision and
hearing loss or Alzheimer’s disease [17]. Similarly, Adefila et.
al. (2016) concluded that the empathy scores of a sample group
of nursing and social care students who took part in a VR
experience to simulate the perspectives of dementia patients
reported in the pre-and post-questionnaires reported a sizable
increase, immediately after the simulation. Furthermore, it
was noted that there was a significant increase in compassion
among students who had medium pre-test scores [17].
Both the Dyer et. al. (2018) and Adefila et. al. (2016) studies
demonstrate that VR immersion training is an effective teach-
ing method to help medical and health professions students
develop empathy [17] and the meta-analysis conducted on the
most current research in the field of immersive virtual reality
by Vilalba et. al. (2018) further propounds this sentiment as it
posits that “perspective taking is more effective than providing
data to feel empathy” and “virtual reality can increase engage-
ment and empathy concern and perspective taking”. However,
it is acknowledged that “much remains to be validated and
experimented” and “there is insufficient evidence and exper-
iments to state that perspective-taking virtual reality (PTVR)
is a more effective method for developing empathy than other
methods,” [18]. In light of this, much research on VR as a
training resource is still required [17], especially relating to
neurodiversity. Accordingly, this study aims to expand on this
research by simulating the symptoms of ADHD.
III. R ESEARCH A IMS AND Q UESTIONS
A. Research Questions:
• RQ1 – How does VR assist software engineers in better
understanding different viewpoints, challenges and be-
haviours of diverse end users and stakeholders through
an empathic approach?
– Motivation: The aim is to explore how VR can
be used in human-centric requirements engineering
using an empathetic approach.
• RQ2 – How does VR help in designing better solutions
for end users with ADHD?
– Motivation: The aim is to see how the VR prototype
helps software engineers in designing better solutions
for end users with ADHD.
B. Research Aims:
• RA1 - To develop a VR environment prototype to explore
empathy in requirements engineering.
– Motivation: The aim is to create a VR prototype
simulating ADHD symptoms in a gym workout
scenario.
• RA2 - To develop initial guidelines for human-centric
requirements engineering – ADHD challenges - using VR
technologies.
– Motivation: The aim is to analyse the questionnaire
results from the study to better understand human-
centric requirements engineering- and to find any
recommendations in gathering requirements from
diverse end users.
• RA3 - To evaluate the created prototype with software
developers, students in training - and other stakeholders
– Motivation: The aim is to answer:
∗ a) whether VR evoked some form of empathy, and
to what extent
∗ b) And whether the VR prototype has helped soft-
ware engineers understanding of designing better
solution for end users with ADHD
IV. R ESEARCH M ETHODOLOGY
A. System development
We used a pre-made highly realistic interactive virtual gym
environment for our participants to do experiments in. This
virtual gym environment was created with Unity, a gaming de-
velopment software, and we also added our own modifications
to fit our research. Our modifications included avatars and
posters for better immersion, labelled as 8, 9 and 10 in Figure
1, sound effect and animation for objects labelled by red and
green arrow respectively in Figure 1. We used a head mounted
display or VR headset called HTC Vive Pro 2 to enable the
participant to experience this virtual gym environment. This
VR headset can track the head movements of the wearer and
display corresponding views making the wearer really feel like
they are in the room. The participants can use the controllers
to grab objects inside the gym, move around and interact with
the virtual tablet.
B. Symptom simulation
According to the Diagnostic and Statistical Manual of Men-
tal Disorders, ADHD is classified into two categories: inat-
tentiveness and hyperactivity and impulsivity. Inattentiveness
can manifest differently in people but some of the symptoms
included are: failing to give close attention to details or making
careless mistakes, difficulty sustaining attention in tasks or
play activities, does not seem to listen when spoken to directly,
does not follow through on instructions, having difficulty
organising tasks and activities, and being easily distracted
by extraneous stimuli, and this is not because of defiance or
lack of comprehension [5]. However, we focus on simulating
two of the inattentiveness symptoms: often having difficulty
sustaining attention in tasks (e.g., difficulty remaining focused
during lectures, conversations, or lengthy reading) and being
often easily distracted (for older adolescents and adults, may
include unrelated thoughts). We simulated these symptoms by
including several visual and auditory distractions in the virtual
environment to distract the participant or draw the attention of
the participant away from the task they were currently doing.
Visual distractions include objects in the background moving
or resizing, for example, a fitness ball in the corner of the
room repeatingly getting bigger then smaller (figure 1: 2,4), in
addition, a dumbbell and an exercise mat would be rolling back
and forth on the floor (figure 1: 1,3). We simulated unrelated
thoughts by playing a random video that covered a small
portion in the field of view of the participant. The video would
follow the participant’s field of view wherever the participant
looked when the visual distraction was activated. Auditory
distractions included background noise such as equipment
noise, chattering noise, and music gradually getting louder
(figure 1: 5,6,7).
C. Interactive gym environment
In this study, we chose the gym as our virtual environment
to simulate ADHD symptoms as most people, including people
with ADHD, go to the gym as their daily routine and some
people use applications on their phone for entertainment or
for instructional purposes. In this virtual environment, we
have a tablet (Figure 1: 11) that contains a poorly designed
fitness application and we aimed to show, from a first person
perspective, the challenges that people with ADHD had using
the application in the gym. The fitness app contained five dif-
ferent lengthy worded instructions, an average of 40 words per
instruction, on how to do each exercise, designed so that the
participant had to pay full attention following the instructions
to complete each exercise, whilst experiencing different levels
of distractions happening around them (from no distractions to
visual distractions only to auditory distractions only to both
visual and auditory distractions) which people with ADHD
would find challenging [19].
Fig. 1. Screenshot of Virtual Gym Environment.
D. Experiment Procedure
We conducted a pilot study on participants to answer our
research questions. Software Engineering, Information Tech-
nology and Computer Science students along with anyone
working within those respective fields were allowed to par-
ticipate. All participants were required to respond to pre-
and post-VR simulation questionnaires. Both questionnaires
contained questions about basic demographic information and
their understanding of ADHD in both a general sense and
within the context of technology. Additionally, the pre-VR
simulation contained questions from Davis’ Interpersonal Re-
activity Index [22] as a measure of the participants’ sense
of empathy and their subscales of perspective taking, fantasy,
empathic concern, and personal distress. Participants were also
encouraged to describe their feelings and thought processes
during the simulation. After the pre-simulation questionnaire,
we provided information on using the VR controls and set up
the VR headset for the participant. The participants were then
prompted to complete the following [23]:
• Navigating to the virtual tablet and selecting “Begin
Exercise”.
• Performing the first exercise with no distractions, com-
pleting 10 repetitions of the Calf Raise.
• Turning on the visual distraction only before performing
the second exercise, completing 10 repetitions of the
Cross-Body Hammer Curl.
• Turning on the audio distraction only before performing
the third exercise, completing 10 repetitions of the Shoul-
der Press.
• Turning on both the visual and auditory distractions
before performing the fourth exercise, completing 10
repetitions of the Dumbbell Scaption.
• Performing the fifth exercise with no distractions, per-
forming ten repetitions of the Dumbbell Squat.
V. R ESULTS
The research we conducted investigates whether the virtual
reality prototype helps software engineers in designing better
solutions for end users with ADHD.
A. Participants
We recruited 13 participants in this study (12 males and
1 female). The participants’ age ranged from 18 to 52 years
(median of 22). All participants selected hearing about the
study from peers in the initial registration form, and were
current or previous students in IT, Computer Science or
Software Engineering. In addition, some participants were also
enrolled in Arts, Business and Economics, or Science. All
participants’ place of residence were currently in Australia.
2 out of 13 participants were working in the technology
industry, both with a Bachelor’s Degree of qualification in the
field of Computer Science. 6 out of 11 students had previous
intern or work experience, with half continuing to work in
their current role. They ranged from frontend and backend
engineers, quality assurance engineers and DevOps. 5 out
of 13 participants knew someone clinically diagnosed with
ADHD.
B. Pre-Experiment Questionnaire
The pre-experiment questionnaire was made up of three sec-
tions: Demographic Details, IRI index, and ADHD knowledge.
The first section began with 4 questions about the demographic
of the participant. Student participants had an additional 7
questions about their university course and any internship
experience, while industry participants had an additional 6
questions. We applied the Interpersonal Reactivity Index (IRI)
to measure dispositional empathy for every participant, which
includes 28 questions on a 5-point Likert scale ranging from
A to E as “Does not describe me well” to “Describes me
very well”, respectively. Following the IRI were questions that
covered participant’s knowledge and understanding of ADHD.
Below we discuss the results from Figure 2 and Figure 3 on
participant ADHD knowledge and understanding in the pre-
experiment questionnaire.
C. Post-Experiment Questionnaire
For the second questionnaire, we designed eight ques-
tions for all participants after the VR simulation had been
completed to compare their results from the pre-experiment
Fig. 2. ”Which of the following is ”not” a symptom of ADHD?” Pre-
experiment questionnaire results on participant ADHD knowledge.
Fig. 3. Pre-experiment questionnaire results on participant understanding
of ADHD on a 5 point Likert scale from “Strongly Agree” to “Strongly
Disagree”.
questionnaire and identify whether the VR platform made a
difference in their understanding of ADHD. The questions
in the post-experiment questionnaire were a combination of
qualitative and quantitative questions. The questions covered
1. Participant’s knowledge of ADHD, 2. Likert scale rating
level of agreement with statements based on the participants’
ADHD understanding, 3. How participants would design the
simulation workout application to be more suitable for people
with ADHD, 4. How the VR prototype changed participants’
understanding of ADHD, and 5. General comments on the
study. Figure 4 and Figure 5 results for participant ADHD
knowledge and understanding are discussed in the positive
findings below.
Fig. 4. ”Which of the following is ”not” a symptom of ADHD?” Post-
experiment questionnaire result on participant ADHD knowledge
Fig. 5. Post-experiment questionnaire results on participant understanding
of ADHD on a 5 point Likert scale from “Strongly Agree” to “Strongly
Disagree”.
D. Positive Findings
Q3.1: “I understand what someone with ADHD would
experience in everyday life”: 92.31% of participants Agreed,
and 7.69% Strongly Agreed. From the pre-questionnaire in
Figure 3, the number of Agreed participants significantly
jumped. ‘Strongly Disagree’, ‘Neither Agree nor Disagree’
and ‘Disagree’ both changed from the pre-questionnaire
having 7.69%, 38.46% and 23.08% respectively, to all
having a scoring of 0%. In the post questionnaire 100%
of participants either ‘Agreed’ or ‘Strongly Agreed’ to this
statement, whilst in the pre-questionnaire 30.77% ‘Agreed’.
Hence,due to this significant increase of positive agreement,
these results suggest the VR Experiment helped participants
understand the experiences of ADHD people.

Q3.2: “I believe software is accessible for people with
ADHD”: The Post-Questionnaire (Figure 5) Results showed
46.15% of participants selected ‘agree’, 38.46% selected
‘neither agree nor disagree’. 7.69% of participants selected
Disagree’ and 7.69% of participants selected ‘Strongly
Disagree’. There was a slight change in these results, where
15.38% scored either ‘Strongly Disagree’ or ‘Disagree’, whilst
there was 0% of participants scoring ‘Strongly Agree’, and a
decrease of 7.69% from ‘Neither Agree nor Disagree’ to a
post-questionnaire score of 38.46%. 46.15% of participants in
both the pre and post-questionnaire ‘Agreed’ to the statement.
This indicates that the VR Experiment made participants
realise software is not as accessible for people with ADHD
as previously thought prior to the experiment, but is not as
conclusive as the difference from pre-questionnaire results to
post-questionnaire results is not substantial.
Q3.3: “I believe ADHD would hinder someone’s ability
to perform tasks in software compared to someone without
ADHD”: Participants had varied responses in the pre-
questionnaire (Figure 3) with ‘Agree’ as the highest
(38.46%), ‘Neither Agree nor Disagree’ (30.77%), followed
by ‘Disagree’ (23.08%) and lastly strongly agree (7.69%).
Whilst 7.69% of participants ‘Strongly Disagreed’ in the
post-questionnaire (Figure 5) to the statement, there was
a significant increase in ‘Agree’ (53.85%) and ‘Strongly
Agree’ (30.77%) and a decrease in ‘Neither Agree nor
Disagree’ (7.69%), demonstrating that the VR Experiment
made participants realise that ADHD does hinders one’s
ability to perform tasks in software applications.
E. Negative Findings
Fig. 6. Q2: “Which of the following is ”not” a symptom of ADHD?” Results,
the pre-questionnaire to post-questionnaire differences
As shown in Figure 6, there was an increase in the
number of correct answers, but also an increase in the
number of incorrect answers (due to participants attempting
an answer from their pre-questionnaire answer of “Do Not
Know”). Whilst an increase in the number of overall correct
answers in the post-questionnaire, and no correct-to-wrong
answers, suggests the VR experiment helped participants
understand the symptoms of ADHD, there was still an
increase in participants who got the question wrong in the
post-questionnaire. Thus, it is inconclusive on whether or not
the VR experiment increased the understanding of ADHD
symptoms as there was both an increase of correct and
incorrect answers. This may indicate some aspects of the VR
Experiment helped some participants in their understanding
of ADHD symptoms, but in others it was not clear enough,
and further research is needed.
Q3.4: “I consider people with ADHD when eliciting
accessibility requirements.” Participants had varying results in
the pre-questionnaire: 23.08% Disagree. The majority being
46.15% Neither Agree nor Disagreed and lastly 30.77%
Agreed with the statement. In the post questionnaire there
was a decrease in the amount that disagreed, 7.69%. There
were 38.46% in both Neither Agree nor Disagree and Agreed,
and lastly there were 15.39% who Strongly Agreed. There
was an increase in the mean participant score, from 3.08
in the pre-questionnaire to a 3.62 in the post questionnaire.
However, this statement can be interpreted in two ways and
thus is ambiguous: A decrease in participant mean score can
imply participants previously thought they did think about
ADHD user requirements, but the experiment showed them
they in fact did not. An increase in participant mean score can
be interpreted as participants will now make more informed
choices and think about ADHD requirements in the future.
Thus, whilst the results show the mean increasing, the nature
of the statement means this data is inconclusive and in the
future further clarification is needed. For example “I believe
I consider people with ADHD when eliciting accessibility
requirement” and in the post-questionnaire rewording it to
“I believe I considered people with ADHD when eliciting
accessibility requirement prior to this experiment”, hence
emphasising the participants own belief that they believed
they consider ADHD users before, to what they think about
their prior actions after the VR experiment
Q4 How would you design the in-simulation workout
application to be more suitable for people with ADHD?
38.46% of participants’ feedback were regarding a potential
improvement of the Tablet Exercise Application with ADHD
people in mind. ”The tablet application could have more
visuals to closely guide the user.” and another participant:
“I would potentially include things like timers or visual
aids of the workouts. . . The app could incorporate music
functionality too, which would again reduce users from being
distracted by external audio sources.” These suggestions, as
well as others,provided improvements that would help ADHD
users navigate and use the Exercise Tablet Application.
30.77% of feedback were regarding improvements of the VR
Experiment Prototype, not the Tablet Exercise Application,
despite further clarification of the question. “Bigger ipad”
and “Music should be quieter / less distracting” were a few
examples of these suggestions. Hence, these participants
did not directly answer the question, and are invalid and
inconclusive results.
15.38% of feedback were ambiguous improvements for the
Tablet Exercise Application and did not seem to focus upon
improvements for ADHD, an example being to “Increase
colour contrast in the UI.” Whilst there was feedback on the
Exercise Tablet Application, the feedback did not seem to
cater directly towards ADHD end users.
7.69% of the feedback was not an improvement; rather,
a comment on the distractions: “Some pages were very
text heavy which made it difficult to read. The distractions
compounded this issue. e.g question 5 and the dumbbell
one were much more difficult to understand.” Thus, these
participants did not directly answer the question, and are
invalid and inconclusive results.
Lastly, 7.69% of participants said that the “Tablet is fine.”
Hence, these participants thought the tablet application was
usable for ADHD users, and needed no further improvements.
Thus, while some feedback given was positive (38.46%),
other participants (53.85%) did not properly understand the
given question and gave feedback that was either ambiguous,
feedback for the VR Experiment Prototype or simply
comments and not improvements. The remaining 7.69% of
participants thought there was no improvement needed. With
the given positive feedback, it suggests the VR Experiment
helped people understand how ADHD people interact with
software, and the participants are able to come up with
potential solutions to tackle ADHD problems.
Whilst there was clarification by the researchers about the
question, a direct rewording of the question is needed so
participants give proper feedback for the tablet application:
“How would you design the Tablet Exercise Application to
be more suitable for people with ADHD?” emphasising the
tablet to lessen participants confusion and give focus to it.
Potentially adding a footnote: “NOTE: this is NOT in relation
to improvements of the VR Gym Experiment Prototype” can
also further clarify understandings.
Q5 How has the VR prototype changed your understanding
of people with ADHD? This open ended question could be
split into two types of responses: 1. Participants commented
it helped in their understanding of distractions, which ADHD
people can’t control. This suggests the VR Experiment helped
them understand what are the potential symptoms of ADHD.
With comments like “People with ADHD will get distracted
easily and that’s not something they can control”, “I didn’t
know things pop out of the room when you work out”, and
“That they face a lot more variety and intensity of distractions
than I realised”.
2. Participants noted it helped them understand what it’s like
to be in their perspective. This indicates participants were
immersed and in the perspective of ADHD people, through
this empathetic approach of VR. It demonstrates how ADHD
symptoms might manifest in their everyday lives and act as
a hindrance. “It has helped me understand how people with
ADHD view distractions, and their focus is impacted much
more than people without ADHD. This would have a negative
effect on the working habits of people with ADHD as they
are much more easily distracted.” and “It gives me an idea
of how to be in their shoes” are just some of the comments
on how participants were affected by the VR Experiment, and
their understanding of people with ADHD.
Hence this question gave an overall positive response to the
VR Experiment, where from the responses all reflected upon
the positive aspects of the VR Experiment giving them a better,
and clearer understanding of ADHD people, and what they
may experience in everyday life. The positive results suggest
that the VR Experiment gave them newfound knowledge of the
experiences of ADHD people through the empathetic approach
of VR, through their perspective and also in understanding of
how the ADHD symptoms might affect software usage.
F. Fitness Level
The fitness level of participants had some effect on the
experiment procedure, as those who did frequent the gym
commented in a similar manner to “I think you should take
into account how often the person does workouts as the
workouts shown in the game were all quite known to me. It
wasn’t hard to do”. These participants excelled in the exercises
and were less likely to be distracted, as the familiar motion
and environment made them more comfortable performing
the exercises. Those less familiar with the gym, or frequent
exercise often took their time in performing the exercises, or
had incorrect form. Thus, these differences can contribute to
one’s level of distraction, where one’s comfort led to them
being less focused on the ADHD symptoms and more focused
on getting the exercise done. In addition, this familiarity
can also affect the time spent within the VR simulation, as
often participants with prior knowledge of the exercises had
less time spent as they understood the task quicker. Thus,
they exited the immersion faster and potentially were not as
immersed as someone who spent longer trying to get a better
understanding of the exercises, thus also being exposed to the
ADHD symptoms for longer.
G. VR Usage
The VR usage rates among the participants were 53.85%
having used VR before, to 46.15% for it being their first
time using VR. This mainly affected how people navigated the
VR environment, the participants with prior usage being more
adept and more comfortable in the VR environment and its
controls, whilst first-time users needed more instructional help
in navigating the VR environment. This can ruin the immersion
for first time users, and thus lessen the empathetic manner
in which they are experiencing VR. This loss of immersion
from first-time users can also be broken by constant asking of
questions to the researchers, asking about controls or what to
do next. Thus, a first-time VR participant could have had a less
immersive experience, which can affect their understanding
of ADHD symptoms as they were less focused upon the
distractions.
In addition, the VR usage can also affect the time spent
within the VR simulation, as the unfamiliarity of the VR
environment can limit the time spent as participants may be
inclined to perform the VR Experiment faster to exit the
simulation sooner.
H. Visual Distraction
It was observed that the video in the middle of the screen
only distracted users to a certain extent. Participants simply
looked to the side to read the instructions on the tablet or
to look at the visual aid posters. They simply ignored this
distraction all together by looking past it. Another aspect of
the visual distraction - the abnormal movement of objects -
was successful in distracting some of the participants. Some
of the comments made by participants during the movement
of objects included: “Haha why is the gym ball expanding?”,
”Pretty creepy. . . the exercise ball” and “I just noticed that
thing moving. . . the green mat”. However, overall it was
observed most participants still completed the exercise to
completion without much trouble.
Thus, having a more relevant video, instead of a “3, 2, 1
countdown” can help aid in focusing more attention to this
visual distraction, such as a person working out, or speakers
blaring the music. Other improvements to this distraction
from a participant included ”...instead have the objects move
towards the person as their presence can feel much larger
than it really is. . . ”. These improvements would help the
Visual Distraction stand out, but also aid in the immersion.
However, the accuracy of the visual distraction being what
ADHD people experience is still in contention due to a lack
of ADHD expertise.
I. Audio Distraction
Most, if not all participants, found the Audio Distraction
distracting, albeit to varying degrees. It was observed that
most participants completed the exercise with the Audio
Distractions on with little added difficulty. Some commented
on its ability to distract them: “I find it so hard to read because
of the music”, and it was observed that one participant took
a deep breath as though overwhelmed by both distractions.
Therefore, the current data is inconclusive to whether the
Audio Distractions fully distracted participants, or was a minor
annoyance and distraction.
It was noted one participant actually found the music to help
in their exercises, keeping in rhythm with the beat, however
when further questioned they were found to like listening
to loud music, thus they were an outlier. This questions
however different participants’ noise thresholds, which can
be different per participant, in what is considered too loud
and thus distracting, or just loud enough to drown out other
distractions.
J. Interpersonal Reactivity Index (IRI)
The Interpersonal Reactivity Index (Davis, 1983) is a “mul-
tidimensional approach to individual differences in empathy”.
[22].
The IRI is used as a measurement of four separate aspects
of empathy: social functioning, self-esteem, emotionality, and
sensitivity to others, categorised into the subscales of Per-
spective Taking, Fantasy, Empathetic Concern and Personal
Distress. With a total of 28 questions using 5-point (0-4) Likert
scale ranging from “Does not describe me well” to “Describes
me very well”, split equally into 7 questions per subscale.
Thus a participant can individually score up to 28 points in a
subscale, with the participants scores shown in the following
Figure 7.
Fig. 7. IRI Scores, displays the overall scores of participants IRI, which
measure an individual’s levels of empathy.
In this particular experiment the results for Fantasy are
insignificant compared to the remaining subscales. Perspective
Taking, Empathic Concern and Personal Distress are important
in the analysis of this experiment. The Empathetic Scores
range from 10 - 20 (Average = 14.46) and the Perspective
Taking 10 - 23 (Average = 16.69), and a Personal Distress
from 9 - 22 (Average = 13.46), as shown in Figure 7. Figure
7 shows a slightly above average mean score of 16.69 in the
subscale of Perspective Taking, which describes “the tendency
to spontaneously adopt the psychological point of view of
others” [22]. Empathetic Concern describes ”other-oriented”
feelings of sympathy and concern for unfortunate others”, and
in this VR Experiment sample there was an average mean
score of 14.46, and lastly, Personal Distress had an average
mean score of 13.46, describing the ”self-oriented” feelings
of personal anxiety and unease in tense interpersonal settings”
[22].
There were some outlier participants; 3 scoring above the
measured average for all subscales and 1 scoring below the
measured average for all subscales. However, overall the mean
scores of the three main subscales of Perspective Taking,
Empathic Concern and Personal Distress were around a middle
score of 14, not being too far off as shown in Figure 7. Thus,
the overall scoring within the IRI were at expected levels.
VI. D ISCUSSION
A. Measuring Empathy after the Simulation
As outlined in the research aims and questions, this study
intends to demonstrate how VR can assist software engineers
in better understanding different viewpoints, challenges and
behaviours of diverse end users and stakeholders through an
empathetic approach. Accordingly, the responses of the pre
and post-experiment questionnaire indicate that a greater pro-
portion of participants recognise what someone with ADHD
would experience in everyday life, and agree with the fact
that ADHD would hinder someone’s ability to perform tasks
in software, at the conclusion of the user study. It can thus be
inferred that after experiencing various symptoms of ADHD in
the VR simulation, participants directly experienced the chal-
lenges of using software that is not intentionally designed for
users with ADHD, and the numerous ways in which it limits
software accessibility, leading to the elicitation of empathy
among software engineers that contributes to an increase in
understanding of how software should be designed in order to
better accommodate users belonging to this demographic. This
is an advantage that using VR for RE possesses over traditional
RE methods [24] as software and requirements engineers have
the ability to develop an intrinsic perception of the ADHD
experience, instead of solely relying on external accounts from
questionnaires and interviews that are prevalent in traditional
RE methods. As such, the responses of the pre and post-
questionnaire have reflected positively on the capability of this
VR simulation to serve as an initial measure for human-centric
requirements engineering using VR technology, as it is able
to elicit empathy among software engineers for people with
ADHD.
B. Observations
In addition to the pre and post-questionnaire, the articula-
tions of participants’ thoughts that were recorded using the
“Think-Aloud Technique” also demonstrate that empathy was
elicited during the experiment. As reported by a participant
during the user testing session, the VR simulation “gave me a
whole new level of empathy,” after attempting to use the work-
out app to complete a set of exercises, whilst being subject
to various visual and auditory distractions. Other participants
shared similar experiences during the simulation, claiming that
the distractions “did distract [them] from the exercise,” and
made using the workout app to complete the exercises more
difficult. The simulation ultimately “helped [them] understand
what ADHD might feel like,” and the challenges that people
with ADHD face in not only when using software, but when
“performing everyday tasks, [because] you get distracted by
everything around you and it’s hard to stay focused.”
C. Threats to Validity
There are numerous factors that potentially threaten the
validity of the results obtained during this study. The fact
that participants are asked to perform different exercises for
each combination of visual and auditory distractions (visual
distraction only, audio distraction only, both audio and visual
distractions), to ascertain which combination made it more
difficult to complete a certain exercise, could have caused the
inherent difficulty of each exercise to affect which combination
of distractions proved to be the most distracting. The relatively
small sample size of 13 users along with the disproportionate
number of 12 male and 1 female participants and the lack of
an ADHD expert to verify the correctness of the visual and
auditory distractions based on ADHD symptoms could have
also skewed the results. In addition the wording of Q3.4 in pre-
questionnaire was vague, resulting in an ambiguous increase
in participant mean score in the pre and post-experiment
questionnaire, and the wording of Q4 in the post questionnaire
produced some invalid short-form responses.
D. Limitations
There were some limitations that we faced throughout the
research, for instance, not having an expert on ADHD in
our team. Due to time constraints and lack of resources, we
were not able to reach out to any ADHD experts experience
our VR prototype and provide feedback on how accurate
these symptoms are. Moreover, by not having an expert, or
anyone diagnosed with ADHD, in the team, we were limited
to a few symptoms that our team had a higher confidence in
replicating based on past researches such as [19],[20],[21].
Some symptoms were considered difficult to replicate or
could not be replicated accurately without experiencing it
firsthand or hearing from someone who experienced it directly.
In addition, due to lack of resources, there was only one
VR headset available for our team to use which slowed
down our development process. Although we had a team of
three responsible for development and used version control
for collaboration, we depended solely on the developer who
had the VR headset to test out the prototype. Furthermore,
performing exercises within a virtual gym environment was
limited due to mobility issues, the headset’s cords hindering
the ability to move freely, and the lack of weight in the VR
controllers, breaking the participant’s sense of immersion.
VII. C ONCLUSION
Requirements elicitation is vital in ensuring the results and
success of software development. Conventional requirements
elicitation often faces challenges in empathising with different
groups of users, especially those with impairments. Inspired
by the wide success of VR in other domains, our research
has demonstrated how the utilisation of VR as an empathetic
approach to human-centric requirements engineering may help
software engineers design better solutions for diverse end
users.
For further work, we plan to improve the effectiveness of the
VR environment by including experts on ADHD and people
who are clinically diagnosed with ADHD as primary research
to ensure the symptoms represented in the VR experiment are
accurate. This VR Experiment was conducted using secondary
research, and adding more symptoms, and accurate symptoms
of ADHD distractions would help in better understanding
ADHD users, and thus help software engineers elicit user
requirements which are beneficial. Additionally, we would
include a different virtual environment which involves an
everyday use case not specifically targeted towards gym users.
Scenarios such as grocery shopping using a shopping list ap-
plication, classroom environment with a computer or portable
device, or similar everyday activities can be explored. This
would be more familiar with a larger proportion of software
engineers, and thus they would be better immersed within the
VR simulation environment. This study also hopes to prop-
agate further research into different neuro-diverse conditions
that could potentially impact users’ ability to use software, and [17] Dyer, E., Swartzlander, B. and Gugliucci, M., 2018. Using vir-
how software can be designed to better accommodate these tual reality in medical education to teach empathy. Journal of
the Medical Library Association, [online] 106(4). Available at:
users. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6148621.
[18] Estrada Villalba, É., San Martı́n Azócar, A. and Jacques-Garcı́a,
F., 2021. State of the art on immersive virtual reality and
R EFERENCES its use in developing meaningful empathy. Computers amp;
Electrical Engineering, [online] 93, p.107272. Available at:
[1] J. Grundy, I. Mueller, A. Madugalla, H. Khalajzadeh, H. O. Humphrey, https://www.sciencedirect.com/science/article/pii/S004579062100255X.
J. McIntosh, and T. Kanij, “Addressing the influence of end user human [19] A.A. Rizzo, J.G. Buckwalter, T. Bowerly, C. Van Der Zaag, L.
aspects on software engineering”, in Proc. of the 16th Int. Conf. on Humphrey, U. Neumann, C. Chua, C. Kyriakakis, A. Van Rooyen, and D.
Evaluation of Novel Approaches to Software Engineering. (ENASE), Sisemore.The Virtual Classroom: A Virtual Reality Environment for the
vol 1556, 2021, pp. 241-264, [Online]. doi: https://doi.org/10.1007/978- Assessment and Rehabilitation of Attention Deficits.CyberPsychology
3-030-96648-5 11. Behavior.Jun 2000.483-499. doi: 10.1089/10949310050078940.
[2] J.C, Grundy, “Impact of End User Human Aspects on Software Engi- [20] R. Adams, P. Finn, E. Moes, K. Flannery, and A. “Skip” Rizzo,
neering”, in Proc. of the 16th Int. Conf. on Evaluation of Novel Ap- “Distractibility in Attention/Deficit/ Hyperactivity Disorder (ADHD):
proaches to Software Engineering. (ENASE), 2021, pp. 9-20, [online]. The Virtual Reality Classroom,” Child Neuropsychology, vol. 15, no.
doi: 10.5220/0010531800090020. 2, pp. 120–135, Mar. 2009, doi: 10.1080/09297040802169077.
[3] Baumer N, MD, MEd, Frueh J MD, 2021, “What is [21] S. -C. Yeh, C. -F. Tsai, Y. -C. Fan, P. -C. Liu and A. Rizzo, ”An
neurodiversity?” Harvard Health Publishing, Available: innovative ADHD assessment system using virtual reality,” 2012 IEEE-
https://www.health.harvard.edu/blog/what-is-neurodiversity- EMBS Conference on Biomedical Engineering and Sciences, 2012, pp.
202111232645. 78-83, doi: 10.1109/IECBES.2012.6498026.
[4] E. K, Lefler, G. M, Sacchetti, and D. I, Del Carlo, “ADHD in col- [22] Davis, M. H. (1980). A multidimensional approach to individual differ-
lege: A qualitative analysis”, ADHD Atten Defic Hyperact Disord, vol ences in empathy. JSAS Catalog of Selected Documents in Psychology,
8, pp.79-93, June. 2016, doi: https://doi.org/10.1007/s12402-016-0190- 10, 85.
9. [online]. Available: https://link.springer.com/article/10.1007/s12402- [23] Men’s Health. (2022, April 5). 25 Best Dumbbell Exercises
016-0190-9article-info. for Building Muscle. Retrieved from Mens’ Health:
[5] American Psychiatric Association, Diagnostic and Statistical Manual of https://www.menshealth.com/uk/building-muscle/a755117/the-10-best-
Mental Disorders (DSM-5-TR), 5th edition, 2013. dumbbell-exercises/?fbclid=IwAR36nYh7FBXn1plwauWGmmBlxgOkq
[6] M. R. Morris, A. Begel and B. Wiedermann, “Understanding the ChYeRnPW5GuI-BgrXZOWzFZC2y IxE.
Challenges Faced by Neurodiverse Software Engineering Employees: [24] O. Wang, X. Liu, B. Cheng, C. Arora, T. Hoang, VR4HcRE: Virtual
Towards a More Inclusive and Productive Technical Workforce” Avail- Reality Platform for Human-centric Requirements Elicitation, 21st IEEE
able: https://dl.acm.org/doi/abs/10.1145/2700648.2809841. International Symposium on Mixed and Augmented Reality (ISMAR’22,
[7] Adefila, A., Graham, S., Clouder, L., Bluteau, P. and Ball, S., 2016. Posters Track), accepted on 16 August.
“myShoes – the future of experiential dementia training?. The Journal of
Mental Health Training, Education and Practice”, [online] 11(2), pp.91-
101. Available: https://www.proquest.com/docview/1787495037.
[8] Herrera F, Bailenson J, Weisz E, Ogle E, Zaki J, 2018,
“Building long-term empathy: A large-scale comparison of
traditional and virtual reality perspective-taking” Available:
https://doi.org/10.1371/journal.pone.0204494.
[9] Pollak, Yehuda PhD*; Weiss, Patricia L. PhD†; Rizzo, Albert A. PhD‡;
Weizer, Merav MD*; Shriki, Liron BA*; Shalev, Ruth S. MD*; Gross-
Tsur, Varda MD*, “The Utility of a Continuous Performance Test
Embedded in Virtual Reality in Measuring ADHD-Related Deficits”,
Journal of Developmental Behavioral Pediatrics: February (2009) -
Volume 30 - Issue 1 - p 2-6, doi: 10.1097/DBP.0b013e3181969b22
Available: https://pubmed.ncbi.nlm.nih.gov/19194324/.
[10] O. Wang, B. Cheng, T. Hoang, C. Arora and X. Liu,
”Virtual Reality Enabled Human-Centric Requirements
Engineering,” 2021 36th IEEE/ACM International Conference
on Automated Software Engineering Workshops (ASEW), 2021,
pp. 159-164, doi: 10.1109/ASEW52652.2021.00041. Available:
https://ieeexplore.ieee.org/document/9680276.
[11] Bhimani, A. and Spoletini, P., 2017, April. Empowering requirements
elicitation for populations with special needs by using virtual reality. In
Proceedings of the SouthEast Conference (pp. 268-270).
[12] Chirico, A., Lucidi, F., De Laurentiis, M., Milanese, C., Napoli, A. and
Giordano, A., 2016. Virtual reality in health system: beyond entertain-
ment. a mini-review on the efficacy of VR during cancer treatment.
Journal of cellular physiology, 231(2), pp.275-287.
[13] T. I. Chowdhury, S. M. S. Ferdous and J. Quarles, ”VR Disability
Simulation Reduces Implicit Bias Towards Persons With Disabilities,”
in IEEE Transactions on Visualization and Computer Graphics, vol. 27,
no. 6, pp. 3079-3090, 1 June 2021, doi: 10.1109/TVCG.2019.2958332.
[14] A. Bhimani, Feasibility of using virtual reality in requirements elicitation
process, Kennesaw State University, 2017.
[15] Ventura, S., Badenes-Ribera, L., Herrero, R., Cebolla, A., Galiana, L.
and Baños, R., 2020. Virtual reality as a medium to elicit empathy:
A meta-analysis. Cyberpsychology, Behavior, and Social Networking,
23(10), pp.667-676.
[16] Shin, D., 2018. Empathy and embodied experience in virtual environ-
ment: To what extent can virtual reality stimulate empathy and embodied
experience?. Computers in human behavior, 78, pp.64-73.